Victims of rape to get more support

SANE nurses comfort women, get evidence

October 13, 2005|By M. Daniel Gibbard, Tribune staff reporter.

After years of lagging behind other states in assisting the specialized nurses who double as rape treatment specialists and forensic experts, Illinois finally is taking a step toward matching their dedication.

Beginning Monday, Atty. Gen. Lisa Madigan's office will have a statewide coordinator for sexual-assault nurse examiners, or SANEs. Her office also will sponsor classes to train more than 100 new ones.

"It is absolutely critical that we have the appropriate individuals in the hospital emergency room when someone who has been sexually assaulted comes in," Madigan said. "One, we want them to understand the sensitivity for people who have been assaulted, and two, so we can secure prosecutions against these individuals."

Longtime nurse examiners praised Madigan's efforts.

"We're finally seeing the light at the end of the tunnel," said Sharon Dimitrijevich, program director for Lake County SANEs and ER director at Midwestern Regional Medical Center in Zion. "Those of us who have been at it a long time have always felt like we've been solo. But we don't feel like that anymore."

Nurse examiners have been around since the late 1970s, but the first pilot programs in Illinois began in 1999, putting the state well behind some others, including Indiana and Texas.

Experts estimate there are 200 to 300 registered nurses in Illinois who have gone through SANE training, but no one has an exact number of how many are practicing. The International Association of Forensic Nurses lists 27 nurses in the state certified as adult- and adolescent-care sex-assault examiners, but certification is a relatively new process and not required by the state.

With no statewide coordination, SANE programs in Illinois have been scattershot. Some counties, such as Lake, Kane, DuPage and several Downstate, are relatively well-staffed, while others, especially in rural areas, have few or none.

Nor does the state have a certification program or standardized training curriculum. Individual hospitals issue guidelines for SANE programs, while the nurses seek accreditation from the forensic nurses association.

"Illinois has better laws for rape victims than many states ... but by contrast, the SANE program doesn't have a real coordinated history," said Lyn Schollett, an attorney for the Illinois Coalition Against Sexual Assault, a statewide network of 33 rape crisis centers. "Mostly it's happened when individual communities have come up with the funds for training."

Securing funding is critical to expanding the programs, experts say. Madigan said she asked for a three-year commitment from the Illinois Criminal Justice Information Authority, which allocates state and federal funds for helping crime victims, but received a one-year grant of a little more than $150,000. That will pay the new coordinator and cover three weeklong training courses of 40 to 60 nurses each.

"We're happy with that, of course, but we'll continue to look for funding to make sure we have more of these nurse examiners available," Madigan said. "Every single time we've offered this training, we've had waiting lists.

"We want to make sure that there are enough nurses that are trained as [SANEs] that wherever a victim shows up, they don't have to wait for somebody or to have someone who is not trained to do the evidence collection."

Indeed, much of the nurses' training is in collecting evidence of sexual assault and handling that evidence in ways that will hold up in court.

For example, although they use the same "rape kits" standard in most emergency rooms, they are better-trained in how to handle the swabs and label the bags to maintain integrity of the evidence. They also learn how to question a potential victim to help find DNA, such as asking if they remember being bitten or kissed in any particular place.

"I know we're going to get better evidence when the collectors understand what we need, why we need it and how to get it," said David Metzger, a forensic scientist who oversees evidence collection for the Illinois State Police.

SANEs may also administer treatments for sexually transmitted diseases or the so-called morning-after pill to prevent pregnancy.

In recent years the examiners have begun using the colposcope, an electronic microscope that can detect vaginal injuries not visible to the eye. That is critical because rape cases often hinge on whether a person agreed to have sex, not whether prosecutors have found the culprit.

"DNA has changed things, but ... identity is not an issue in most rape cases," Schollett said.

Beyond that, nurse examiners are volunteers and passionate about the work.

"I think they have the special sensitivity and desire to work with these victims. They have to have chosen to do this," said Lynn Osborn, associate director of the Lake County Council Against Sexual Assault.

The nurses go through a 40-hour training course and must complete a certain number of supervised real-life tasks--exams, evidence collection--before applying for certification.

Many nurses train in Indiana at the Ft. Wayne Sexual Assault Treatment Center, where the weeklong course costs $600. Some pay for training themselves, but many are sent by hospitals that have received state grants.

"A true SANE program is when you have 24/7 coverage," said Nancy Salamie, an emergency-room nurse and trained examiner at Edward Hospital in Naperville. "The goal is for every sex-assault patient to have a SANE nurse."

The hardest part can be finding nurses who want to do the work, which can be mentally draining and require them to appear as witnesses in court.

That was part of the challenge at Midwestern Regional Medical Center, which began its program in the late 1990s and is now fully staffed.

"It involved finding people who are passionate and can provide the best care possible to sexual-assault victims," said Anne Meisner, senior vice president of patient care services. "We have staff who are very committed to this. We're very proud of them."